Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
71
INTERPRETING IN MENTAL HEALTH:
AN EFFECTIVE COMMUNICATION
FACILITATION PRACTICE
Noelia Burdeus-Domingo
Université Laval
Abstract
Immigration is an expanded phenomenon that
characterises our present societies. It brings with it new
challenges and new needs to be faced by administrations.
Those unquestionably affect the healthcare sector, urging
for it to be adapted to treat users from different linguistic
and cultural backgrounds. Public Service Interpreting
guarantees effective communication in multicultural and
multilinguistic contexts. It is increasingly necessary in
the healthcare sector of the current multicultural
societies. The need for Public Service Interpreting is
experienced with greater intensity in such services as
mental health, where anamnesis constitutes the principal
route of diagnosis for a later treatment, in which
linguistic and cultural comprehension is essential.
However, not all kinds of interpreting services should be
accepted. Some quality standards –that are only achieved
thanks to an appropriate training– must be required.
Healthcare interpreters must be properly trained in
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
72
regard to languages, interpreting techniques, etc., but
also in multiculturalism. An extensive knowledge of
both involved cultures is essential to make healthcare
interpreters able to assist healthcare providers by finding
out cultural biases in mental health patie4nts’ discourse,
as those could affect communication in healthcare.
In this paper, I present some of the results of a multiple
case study that describes, analyses and compares the
healthcare interpreting services provided in the cities of
Barcelona and Montreal. The present article outlines,
from the interpreter’s perspective, the benefits that
interpreting brings to communication in healthcare and
describes the negative effects that unprofessional
interpreting services could entail.
Keywords: Cross-cultural communication; effective
communication; intercultural mediation; interpreting;
mental health
1. INTRODUCTION
Like many countries inside and outside of Europe, Spain
has experimented, in its most recent history, a great
increase in immigration rates. Newcomers have all sorts
of different profiles: some of them immigrated for
working reasons, others moved into the country with the
intention of becoming permanent residents, while others
are temporary residents staying in Spain for touristic
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
73
reasons. They have different economic and legal statuses
in the country and bring with them different habits and
customs that coexist and interrelate in everyday life. This
has set up a new social reality with new needs and new
interests, but also with new risks of polarization in
society, social exclusion of ethnic minorities,
marginalization and conflict. New challenges and new
needs are consequently imposed in our societies, which
affect directly the healthcare sector, since its users have
very diverse linguistic and cultural backgrounds.
Spanish administrations offer many ad hoc solutions,
among which we find professional and volunteer
interpreters. However, in order to achieve better quality
guarantees, there is a need to increase the awareness of
interpreting as a specialised professional activity. In
Catalonia, different professional figures share the task of
interpreting between healthcare providers and their
patients, which doesn’t make the situation any better.
Those professionals have different functions that are
only slightly defined. As a result, they often assume
responsibilities that don’t belong to the interpreting
professional (Linguamón, 2010). Moreover, Arumí,
Bestue, García-Beyaert, Gil-Bardají, Minett, Onos, Ruiz
de Infante, Ugarte, & Vargas-Urpí (2011), observed a
lack of specific training for Catalan healthcare
interpreters, which frequently lead to unprofessional
performance. Given their lack of training, these
interpreters are considered assistants that help other
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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professionals perform their duties. For that reason, they
are called only in very punctual cases. In fact, in many
occasions family members, friends, neighbours or other
people accompanying the patient are asked to intervene
as spontaneous interpreters instead.
According to Hale (2007), the quality of communication
between healthcare providers and patients conditions the
trust of the latter in the proposed treatments and, thus,
affects the quality of healthcare services. Specially so in
mental health services, where trust is the basis for any
clinical encounter, as it is the key into the patients’
worlds, without which they could never be properly
treated. For this reason, professional interpreting services
should be required. Neglecting to do so would not only
hinder allophone patients’ integration into our society,
but would also be violating their rights to equal access to
healthcare services. Failure to optimise interpreting
services would also increase the costs of public health
services, since some of the clinical encounters would be
banal and unsuccessful due to communication problems.
That would, in turn, originate new appointments
dedicated to solve problems dealt with in previous
encounters. Investing in quality interpreting services
could prevent such situations.
By examining the distinct interpreting services offered in
Barcelona and Montreal, we could state how each one of
them improved communication between allophone
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
75
patients and healthcare providers. As reported by
Angelelli (2004), interpreting services are strongly
influenced by the social and cultural contexts in which
they are offered. This was taken into account when doing
this study. The comparison allowed outlining similarities
and differences between healthcare interpreting settings
serving a vast population of allophone immigrants in
each city, even though at a different level of
professionalization; healthcare interpreting services
being at their early stages in Barcelona, and already
settled and with a wider tradition in Montreal. This
comparison allowed us to list the benefits that such
services bring to healthcare communication, as well as to
describe the negative effects of unprofessional
interpreting.
2. IMMIGRATION, MENTAL HEALTH
AND EFFECTIVE COMMUNICATION
Migratory processes modify many aspects of a person’s
life. They distance the person from their loved ones, as
well as from different aspects that define them, as their
language, their customs, their land, or their culture. All
these changes can negatively affect the health of
immigrants. Based on that, it can be stated that the
increase of the migratory flows that a country receives,
changes the profile of its healthcare services’ users.
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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Conforming to Carballo (2006), immigrants in need for
healthcare services are often in a situation of alienation
and chronic sadness. In addition, they are generally far
away from their families and live in a constant state of
economic or even legal insecurity (as many of them have
not reached a stable immigration status in the host
country). They also find difficulties with both the
language and the culture of their host country. All this
adds up to the fact that they often experience a social and
political-legal rejection, which complicates the task of
communication with their host society’s public service
providers. This adds to the intrinsic difficulties of living
in a new place, such as ignorance or lack of command of
the local language(s) and the main culture (including the
healthcare culture). Still, according to Valero-Garcés
(2014), these people always modify, acquire and adopt
changes of behaviour (to some extent) when they
migrate into another country.
Based on Martincano (2003), Valero-Garcés (2014)
states that the most important concerns regarding the
access of immigrants to national health systems in the
21st century are active abandonment, lack of knowledge,
bureaucratic complexity, obstacles imposed by local
authorities, and difficulties with the language, as well as
cultural and religious issues, and social and working
difficulties. The author also points out that the
professional's social interference can affect the quality of
the healthcare services provided. She adds that, when
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Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
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working with patients of immigrant origin, healthcare
providers can reveal emotions (ethnocentrism,
xenophobia, racism, segregation, prejudices, stereotypes,
discrimination, rejection, aggression, exclusion, etc.),
especially when working with patients that inspire
feelings of oppression and prejudice. Likewise, the
author insists that a vast majority of immigrants tend to
suffer the so-called Ulysses syndrome, defined by
Martincano (2003) as a disease related to chronic stress
that involves loneliness, the struggle for survival,
frustration, and the feeling of failure that many
immigrants feel.
In this sense, Qureshi Burckhardt et al. (2009) explain
that the migratory process itself, or the simple fact of
belonging to a minority ethnic group, are sources of
stress that can affect the individual's mental health. All
of this proves that immigration and culture have a huge
impact on people’s health and healthcare. The authors
add that the expression of possible psychiatric disorders,
the interpretations and given explanations, or the way of
searching for relief are strongly linked to culture and
therefore biased by it.
It is therefore important to remember that equal access to
public services is a fundamental human right, which
implies, to begin with, understanding and being
understood to eliminate communicative obstacles that
may interfere in the proper provision of such services. In
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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this sense, García-Beyaert (2008) defends the "right to
effective communication", defining it as the right of
every individual to understand and to be understood
when in contact with public institutions, so that
communication barriers do not impede the respect of
allophone speakers’ fundamental rights covered by these
institutions.
When in a vulnerable situation, it is especially difficult
(as well as important) to clearly communicate accurate
information. Reaching effective communication is even
more complicated when cultural differences are not
properly taken into account and handled by a
professional able to promote an effective understanding.
Along these lines, Gumperz (1971) explains:
Effective communication requires that speakers
and audiences agree both on the meaning of
words and on the social import or values
attached to choice of expression… We will use
the term ‘social significance’ or ‘social meaning’
to refer to the social values implied when an
utterance is used in a certain context.
In this sense, Ayonrinde (2003) declares that when the
same way of interpreting the world is not shared,
participants can have different expectations regarding the
nature and form of the healthcare provider-patient
relationship. This is where the mediation of a competent
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
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interpreter becomes especially important. Without such a
mediation, as Qureshi Burckhardt et al. (2009) insist,
even though an understandable exchange of words can
occur, there will be no effective communication, as the
context and meanings are different for each person. To
add up to this there is the fact that every language and
every culture have their own way of expressing and
decoding emotions, which may not be shared by both of
the conversational partners in cross-cultural
consultations.
Even though the need of a professional interpreter that is
able to transmit messages from one language into
another and handle with care cultural differences is
obvious for all specialties of the medical field, it is even
more important in mental health, where patients’ realities
can be distorted, and such distortions will often affect
their discourse.
As stated by Halliday (1970), “we use language to
represent our experience of the processes, persons,
objects, abstractions, qualities, states and relations of the
world around us and inside us”. That is why effective
communication is essential in mental health and
professionalised interpreters are needed to guarantee an
adequate treatment of allophone immigrant users.
Leanza, Miklavcic, Boivin & Rosenberg (2014) maintain
that ethnocultural identities and social position shape
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Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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patients’ choices on the language used to express their
own experience. The authors state that languages have
different nuances of meaning linked to social
predicaments, developmental experiences, and the
structures of family and community life. These
determine the language of subjective experience and
emotion, which is essential for mental health assessment
and intervention. For that reason, interpreting in mental
health requires the understanding of emotional meanings
that are culturally biased and the ability to transfer them
into the other culture without neglecting the patient’s
language choices. In fact, as stated by Leanza,
Miklavcic, Boivin & Rosenberg (2014), patients’
decisions to use or avoid specific languages can provide
important clinical information. To convey these nuances
of language use, clinicians and interpreters must
understand psychological dynamics, respect patients’
modes of self-presentation, and attend to nonverbal
communication.
3. THE STUDY
3.1. Method
This article is a contribution derived from the research
carried out for the doctoral thesis La interpretación en
los servicios públicos en el ámbito sanitario. Estudio
comparativo de las ciudades de Barcelona y Montreal
[Public Service Interpreting in Healthcare Settings. A
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
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Comparative Study Between the Cities of Barcelona and
Montreal] (Burdeus-Domingo, 2015). This research’s
main objective was to analyse healthcare interpreting
settings from a threefold perspective: that one of the
interpreters, that one of the Administration (conformed
by the perspectives of healthcare professionals and those
of interpreting service managers), and that one of the
users.
The present article aims to describe the benefits that
healthcare interpreting brings to communication in the
medical context, as well as the negative consequences of
using non-professional interpreters. This is done by
examining the information reported by interpreters
working in Barcelona’s and Montreal’s healthcare
sectors. The exposed information was obtained through
the above-mentioned multiple case study, which
followed a replication-based methodology. In other
words, it reproduced the same research process in
Barcelona and Montreal, with the subsequent
comparison of the data obtained, which allowed reaching
significant conclusions.
3.2. Data collection instruments and
procedures
Questionnaires were distributed in different languages
(Spanish, English, French, Romanian, Russian, Arabic
and Chinese) to allophone users of the healthcare
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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interpreting services of both cities. Moreover, interviews
were conducted in the local languages (Spanish and
Catalan in Barcelona, and English and French in
Montreal) to the rest of the subjects involved.
The first phase of data collection took place between
September 2011 and June 2012. It collected all possible
data to outline a general image of the healthcare
interpreting services offered in Barcelona. The second
phase of data collection, corresponding to the city of
Montreal, took place between September 2012 and May
2013. In this phase, information was collected to
describe the services offered in the Canadian city.
For the design of the questionnaires, we relied on the
model employed by the research group MIRAS (Arumí
et al., 2012) in their project entitled Traducción e
Inmigración: la formación de traductores e intérpretes
para los servicios públicos, nuevas soluciones para
nuevas realidades [Translation and Immigration:
Translators’ and Interpreters’ Training for Public
Services, New Solutions for New Realities] which, in
turn, was elaborated based on the models already
contrasted and used by Valero-Garcés & Lázaro-
Gutiérrez (2008). They included closed questions
(yes/no, multiple choice) and open-ended questions
where informers could extend their responses.
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
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On the other hand, different semi-structured interviews
were designed, based on a model designed for a previous
study (Burdeus-Domingo, 2010). An interview script
was designed for each informant profile. These scripts
were flexibly used in interviews, depending on the
information flow shared on each interview.
3.3. Population, sampling and corpus
A random sample was drawn, in which participants were
randomly chosen among those who claimed to be
available at the different participating health institutions.
The corpus of this study was formed from the set of
recordings and questionnaires obtained in the
observation phase. 81 recorded interviews and 110
questionnaires were compiled and analysed. Specifically,
in Barcelona, between September 2011 and June 2012, 9
service managers, 15 interpreters and 26 healthcare
professionals from a total of 10 healthcare centres were
interviewed, of which 4 were primary care centres (CAP
Sagrada Familia, Cap Collblanc, Cap Drassanes, Cap
Trinitat Vella y CAP Fondo) and 6, hospitals (Hospital
Vall d’Hebrón, Hospital Sant Pau, Hospital Can Ruti,
Hospital del Mar, Hospital General de l’Hospitalet,
Hospital Dos de Maig). Among the participants in
Barcelona there were 11 physicians, 8 nurses, 4 social
workers and 3 administrative assistants. On the other
hand, in Montreal, between September 2012 and May
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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2013, two managers of translation and medical
interpreting services were interviewed (the one of the
Montreal Interregional Interpreters Bank and the one of
the Montreal Children’s Hospital’s Sociocultural
Consultation and Interpretation Services), 16
interpreters, and 13 healthcare professionals belonging to
different healthcare institutions in 2 healthcare and social
services centres (CSSS de la Montagne and CSSS
Jeanne-Mance) and a hospital (Montreal Children
Hospital): 2 physicians, 1 unit coordinator, 3 nurses, 5
social workers, 1 nutritionist and 1 administrative
assistant. The following table synthetises the instruments
applied and the corpus obtained:
Instrument Subject profile Barcelona Montreal
Interviews Healthcare
interpreters
15 16
Healthcare
professionals
26 13
Service
managers
9 2
Questionnaires Users 101 9
Table 1. Instruments and corpus.
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Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
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3.4. Data analysis
For the analysis of the data obtained through
questionnaires, a quantitative analysis was applied.
When analysing the data obtained through closed
questions, the actual percentages were calculated (i.e.,
including blank answers), although in some cases we
also presented the absolute frequency to facilitate data
interpretation. The open answers were translated into
Spanish and analysed using content analysis techniques,
as was done with interviews.
The data obtained through interviews was analysed
following qualitative content analysis techniques,
systematically describing the meaning of qualitative
material by classifying it according to a series of
categories that formed our coding framework (Schreier,
2012). This method allowed us to handle a huge amount
of material, leaving for future investigations all the
information that could not be grouped within the coding
framework previously established in a thematic mesh
(created when designing the data collection instruments).
Finally, to validate the obtained results, a triangulation of
the information obtained was made. Triangulation
allowed drawing concrete and truthful conclusions from
the results, decreasing the potential risk of subjectivity
by comparing data of diverse origin. A multiple
triangulation was performed, combining data and
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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methods triangulation. Trough data triangulation we
compared the results obtained from each participant
profile, whereas through methods triangulation we
compared the data obtained with the application of the
two instruments (interviews and questionnaires). A first
triangulation of the data obtained in each city allowed us
to draw a general image of each city’s healthcare
interpreting services, taking into account as many details
as possible. Also, the triangulation of the representative
data of each city was triangulated in order to extract the
final conclusions of the study, which included topics
such as the ones dealt with in this article: the benefits
provided by the examined healthcare interpreting
services or the negative effects of unprofessional
interpreting in healthcare.
3.5. Limitations
We are aware of the limitations of this research, since we
were forced to restrict ourselves to a relatively small
sample in some cases. Despite the effort made to achieve
a comparable volume of data in both cities, this was only
achieved for some profiles. This was due to the
characteristics of the services, on the one hand (since
Montreal’s healthcare interpreting services are much
more centralised than Barcelona’s and, therefore, the
number of service managers is reduced to two) and to the
restrictions imposed by research ethics in the healthcare
field, on the other hand. In fact, research ethics
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
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restrictions complicated considerably the task of getting
questionnaires filled in by users of Montreal’s services
of healthcare interpreting. Nevertheless, this research
presents a first inclusive approximation (which takes into
account the opinion of all the subjects related to cross-
cultural communication through an interpreter in
healthcare) to the benefits of professional healthcare
interpreting.
4. OVERCOMING COMMUNICATION
BARRIERS IN HEALTHCARE
Both cities have different ways of facing communication
barriers when allophone users demand healthcare
services. At best, interpreting services will be provided
to guarantee communication between allophone patients
and healthcare providers. However, it must be stated that
other methods of communication are also used. These
include consultations without intermediary or the use of
voluntary interpreters (only in Montreal), as well as the
use of gestures, drawings, multilingual linguistic
material or multilingual software, or even the
intervention of friends or family members (sometimes
underage) as accidental interpreters, bilingual health
professionals, or phone interpreting services.
4.1. Description of the examined healthcare
interpreting services
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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Having a greater tradition, Montreal’s interpreting
services have a more solid structure and a greater
professional recognition, within the limits of an
emerging profession.
In Barcelona, healthcare centres that have interpreting
services have few people performing those tasks.
Working only in the healthcare sector, they are destined
to healthcare centres but contracted by external entities.
In Montreal, however, the Interregional Interpreting
Bank provides interpreting services to different
institutions in the healthcare sector, but also in social
services and education. Although these services are
available, the Montreal Children Hospital has its own
transcultural service (the Sociocultural Consultation and
Interpretation Services) where healthcare interpreting
services are offered, in addition to multicultural training
and counselling.
It is worth noting the greater difference between both
cities’ healthcare interpreting services, which resides in
the chosen professional profile. Barcelona has two
different professional profiles in in-person interpreting
services in the healthcare sector (intercultural mediators
and community health agents), which reveals a lack of
consensus in this respect. However, Montreal established
the professional profile of the cultural interpreter. To
compare the three profiles mentioned, all we need is to
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
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examine their main functions. The following table
synthesises the main differences between the three:
Professional
profile
Main functions
Intercultural
mediator
To facilitate communication
between healthcare professionals
and users, interpreting the different
cultural codes.
Community health
agent
To facilitate communication
between the parts of the triadic
conversation in the healthcare
sector.
To develop health promotion
activities.
To provide healthcare advice.
Cultural
interpreter
To facilitate communication
between professionals and users,
interpreting both verbal and non-
verbal language, as well as the
different cultural signs, without
interfering in the conversation.
Table 2. Barcelona’s and Montreal’s healthcare
interpreting professional profiles and their functions.
Differences in the training programs add up to the ahead-
mentioned ones. While training requirements for this
type of professionals in Barcelona are limited to an
intercultural mediation course, in Montreal specific
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Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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training in public service interpreting is required.
Although this specific public service interpreting training
remains quite limited and differs from what could be
considered an ideal training for this practice (Burdeus-
Domingo, 2015), it is observed that Montreal’s
professionalism levels are more advanced.
4.2. Benefits of interpreting services in
healthcare
Even though the healthcare interpreting services
provided in Barcelona and Montreal have different levels
of professionalization and face different budgetary
problems, there are no doubts that they all have shown to
provide huge benefits to the healthcare sector, both at a
healthcare institution level and for their professionals,
their users and the relationship between them, as well as
for society as a whole, although it can be supposed that
those benefits are experienced at different levels in each
city.
Observing the information collected in the interviews to
interpreters of both cities, healthcare interpreting
services have provided many benefits to the relationship
between healthcare providers and patients. They tend to
highlight the following:
1. Better understanding of the conversational exchange.
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Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
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2. Increased trust between patients and healthcare
providers.
3. Increased comfort of patients and healthcare
providers in cross-cultural consultations.
4. Increased cultural awareness.
5. Promotion of rapprochement between the parties.
6. Increment of healthcare professionals’ safety at
work.
7. Improvement of healthcare quality.
8. Improvement of the implementation of treatments
and, therefore, of the result of the provided care.
9. Decrease of misunderstandings.
10. Increased appreciation of healthcare services by
allophone users.
11. Increased feeling among allophone users of
belonging to a healthcare centre.
With regard to the benefits brought by their services to
the healthcare centres that require them to treat
allophone users, interpreters highlighted that healthcare
centres get:
1. To respect the right of allophones to access public
health services.
2. To reduce the number of needed consultations.
3. To save time and money.
4. To attend a wider population, making possible a
decrease in the risk of exclusion.
5. To improve access to healthcare services.
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Learning E, 5,
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6. To reduce the number of missed appointments.
7. To bring allophone users closer to healthcare
institutions.
8. To promote a reassuring feeling among healthcare
professionals.
9. To optimise the exploitation of healthcare resources.
10. To increase success in cross-cultural and
multilinguistic communication.
11. To promote the comfort of healthcare professionals
within their own work.
12. To increase the accomplishment of treatments.
13. To promote allophone users’ communicative
independence by not having to rely on their family or
friends to ensure communication.
14. To reduce medical errors by increasing the success of
medical practices (diagnostics, assessments, etc.).
15. To improve allophone users’ trust in the healthcare
system.
16. To promote the healthcare centre amongst allophone
users, therefore amplifying its number of clients.
When questioned about the benefits bought by healthcare
interpreting services to healthcare providers, the
interpreters interviewed include in their answers:
1. Saving efforts to initiate communication.
2. Success in communication.
3. Time saving.
4. Increased security and reassuring feelings.
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Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
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5. Increase of the effectiveness of their work.
6. Avoidance of problems caused by
communication failures.
7. Cultural awareness.
8. Reduction in the number of medical errors by
increasing the success of medical practices
(diagnostics, assessments, etc.).
9. Reduction of confrontations caused by cultural
misunderstandings or lack of understanding.
According to the interviewees, society benefits from
healthcare interpreting services as long as those:
1. Facilitate access to the healthcare services to
allophone users.
2. Make it possible to provide adequate care to
foreigners.
3. Promote economic savings in the healthcare
system.
4. Facilitate rapprochement.
5. Help to better prevent disease.
6. Eliminate prejudices.
7. Promote cultural awareness.
8. Facilitate allophones’ integration.
9. Promote peaceful coexistence: The collected data
shows that, in the interpreters’ opinions, this is
obtained by healthcare interpreting services as
they promote the respect of the rules governing
each healthcare system, encourage mutual
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Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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understanding, help increasing allophone users’
appreciation of healthcare systems, encourage
user’s integration in society, and make social
exclusions decrease.
Finally, the interviewed healthcare interpreters consider
that the benefits that their services have provided to their
users include:
1. Easier access to healthcare services.
2. Promotion of allophone user’s communicative
independence, by not having to rely on their relatives
or friends to communicate.
3. Reduced risk to see their health worsen due to
communication problems.
4. Increased trust on healthcare providers.
5. Possibility to ask questions to healthcare providers.
6. Better understanding of the conversational exchange.
7. Increased reassuring, comfort and safety feelings.
8. Greater success of medical practices (diagnostics,
assessments, treatments, etc.).
9. Understanding of the particularities of the local
healthcare system.
10. Greater accuracy in the information received.
11. Greater success when communicating in the
healthcare sector.
12. Promotion of allophone immigrants’ integration.
13. Better knowledge of the services offered by the host
society.
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
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4.3. Negative effects of unprofessional
interpreting in healthcare
In both studied healthcare contexts, allophone users can
be assisted through the intervention of a relative or friend
to help them communicate. Barcelona’s healthcare
professionals often ask them to attend their medical
appointments accompanied by a third person able to do
so. When they do it, interpreting services are frequently
discarded, even if they are available. Instead, in
Montreal, family members and friends are only asked to
mediate when no professional interpreter is available.
Even though the intervention of family members and
friends could eventually work, interviewees from both
cities state that, as they have observed when working
with patients who have sometimes been treated through
the mediation of these intermediaries, they have shown
to regularly fail to transmit the healthcare message
properly, as they repeatedly commit interpreting
mistakes that an interpreter would not make. These
mistakes, in our informers’ opinion, can, among other
things, cause harm to both the user and the healthcare
professional. This is because, as they have noticed,
although the level of linguistic command family
members and friends have is every so often higher than
that one of the user who requests their intervention, it is
frequently insufficient when it comes to communicating
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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in specialty areas such as healthcare. Moreover, as
specified in the information obtained, the mediation of
user's family members and friends violates the user’s
privacy, as it breaks with the confidentiality principle
that governs all healthcare consultations.
The interviewed interpreters claim that some users refuse
to address some issues in front of their relatives and
friends. They add that, although this can also happen
when having the services of an interpreter, it occurs to a
lesser extent in the second case, since when they get to
know the interpreting services, they are aware that
interpreters’ code of ethics asks them to safeguard
professional secrecy.
Interpreters also considered worth highlighting that, in
both cities, there have been cases in which those family
members intervening as ad hoc interpreters have been
minors that attend school in the host country, and, for
that reason, they have a certain command of the majority
language. According to our informers, this practice is
totally discouraged, especially in Montreal’s healthcare
field, for several reasons, which include the protection of
children’s interests, who should not neglect their
responsibilities (such as going to school, etc.) in order to
intervene as ad hoc interpreters in other people’s
consultations, or the stigma that can cause within a
family that a young child interprets for their parents, by
altering the power relations within it, given the greater
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
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linguistic knowledge of the minor. Also, the
interviewees insist that, when a minor user intervenes
interpreting in their own case for their parents, they may
be able to hide relevant information for their own
interest, altering the outcome of the consultation.
5. CONCLUSIONS
When health care providers do not use the existing
interpreting services, either because they are not
available or because they prefer not to do so, there are
many and varied ways in which they establish (or try to
establish) communication with allophone users, being
the mediation of the patient’s relatives or friends the
most commonly used.
As we have seen, in Barcelona many healthcare
providers tend to ask their patients to bring someone
with them to facilitate communication in their
consultations (even if there are interpreters available).
On the other hand, in the healthcare area of Montreal, the
mediation of patient’s relatives or friends is only
practiced in case of unavailability of interpreting
services, in order to avoid information filters caused by
non-professional interpreters. This proves that Montreal
healthcare professionals have a greater understanding of
interpreting, which is with no doubts due to the longer
tradition of Montreal’s interpreting services. Their
experience in the use of these already consolidated and
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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well-organised interpreting services has allowed them to
experience the many benefits that interpreting brings to
cross-cultural consultation.
This article corroborates the terrible consequences of
using non-professionals as interpreters observed in
previous studies, including, as seen in the previous
section, aspects such as the loss of relevant information
or the disadvantage within the public health system of
users from linguistic minorities (Vásquez & Javier,
1991; Cambridge, 1999, etc.). Also, after exposing the
benefits of healthcare interpreting services and the
negative consequences of the mediation of patients’
relatives or friends, we ratify the findings of previous
investigations such as that one of Munoz & Kapoor-
Kohli (2007), who explain the advantages and
disadvantages of this kind of practices. As we have seen,
among the advantages of using informal interpreters are
the immediate availability and the absence of costs for
healthcare centres, while their disadvantages include, as
the results of our research have indicated, the breach of
confidentiality, interpreting mistakes, lack of neutrality,
self-censorship, investment of roles in the family and
even truancy (in case of minors).
With regard to professional interpreters, the advantages
noted include respect for confidentiality and quality
interpretation. However, our results imply the
importance of having interpreters formed in healthcare
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
99
interpreting (which remains, to some extent, a pending
task).
The results of our research have also shown that often,
despite the fact that patient's relatives and friends might
have a greater linguistic competence in the local
language, their mediation hardly ever leads to effective
communication. This is because during medical
consultations, specialised terminology is used which,
although they could be part of the current vocabulary of
any native speaker, they are not always part of non-
specialist allophones’ vocabulary. This idea had been
previously exposed by Valero-Garcés (2014) and has
been backed up by the present research.
As we have seen, cross-cultural consultations have
special peculiarities that only a professional interpreter
with a specific training in healthcare interpreting will be
able to face, ensuring effective communication. That is
why, to conclude, we insist that, while existing
healthcare interpreting services provide undeniable
benefits, the idiosyncrasy of the healthcare sector and the
possible negative consequences of a poor interpreting
practice require a greater professionalization of these
services, which will adapt this practice to real needs.
This professionalization begins with adapting interpreter
training to real needs. For interpreters to take their
proper place in healthcare settings, they should be
properly trained not only in the particularities of clinical
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
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exchange, multiculturality and the healthcare sector, but
also in the idiosyncrasy of a specialty so particular and
frequent amongst immigrant patients as mental health.
This would eventually end up adding to the benefits
brought by healthcare interpreting services and reducing
the bad consequences brought by poor interpreting
practices.
Acknowledgements
This research was supported by the Universitat
Autònoma de Barcelona. We thank our colleagues from
the research group MIRAS who provided insight and
expertise that greatly assisted this research. We also
thank the Centre d’Études Ethniques des Universités
Montréalaises, for opening their doors to the author of
this paper. Especially to Dr. Michel Pagé, honorary
professor of Université de Montréal’s Psychology
Department, for his altruistic advice and counselling.
We thank Dr. Yvan Leanza, professor in Laval
University’s School of Psychology, and director of the
Psychology and Cultures lab, for his comments and
advice, that greatly improved this manuscript.
We would also like to show our gratitude to all the
informants for sharing their pearls of wisdom with us
during the course of this research, especially to Isabelle
Hemlin, director of the Montreal Interregional
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
101
Interpreting Bank, and Marie Serdynska, coordinator of
the Montreal Children’s Hospital’s Sociocultural
Consultation and Interpretation Services, for kindly
allowing us access to Montreal’s healthcare interpreting
field. Finally, we thank the healthcare institutions that
participated in our research for this opportunity to
contribute with our findings to the field of research in
healthcare interpreting.
REFERENCES
Angelelli, C. (2004). Medical Interpreting and Cross-
cultural Communication. Cambridge: Cambridge
University Press.
Arumí, M., Bestué, C.; García-Beyaert, S.; Gil-Bardají,
A.; Minett, J.; Onos, L.; Ruiz de Infante, B.; Ugarte,
X. & Vargas-Urpí, M. (2011). Comunicar en la
diversitat. Intèrprets, traductors i mediadors als
serveis públics. Barcelona.
Arumí M, Bestué, C.; García-Beyaert, S.; Gil-Bardají,
A.; Minett, J.; Olaciregui, M.; Onos, L.; Ruiz de
Infante B.; Ugarte, X. & Vargas-Urpi, M. (2012).
Traducció i immigració: la formació de traductors i
intèrprets, noves solucions per a noves realitats. In:
M. García (Coord.). Recerca i Immigració IV.
Convocatòria ARAFI-2008. 1 ed. Generalitat de
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
102
Catalunya, Departament de Benestar Social i
Família, pp.157-183.
Ayonrinde, O. (2003). Importance of cultural sensitivity
in therapeutic transactions. Dis Manag Health
Outcomes, 11(4), 233-248.
Burdeus-Domingo, N. (2010). Interpretación en los
servicios públicos en el ámbito sanitario en la
provincia de Barcelona. Universidad Autónoma de
Barcelona.
http://ddd.uab.cat/pub/trerecpro/2010/hdl_2072_17
0116/Treball_de_recerca_Noelia_
Burdeus_Domingo.pdf
Burdeus-Domingo, N. (2015). La interpretación en los
servicios públicos en el ámbito sanitario. Estudio
comparativo de las ciudades de Barcelona y
Montreal. Universidad Autónoma de Barcelona.
www.tdx.cat/bitstream/handle/10803/310427/nbd1
de1.pdf?sequence=1
Cambridge, J. (1999). Information Loss in Bilingual
Medical Interviews through an Untrained
Interpreter. The Translator, 5(2), 201–219.
http://doi.org/10.1080/13556509.1999.10799041
Carballo, M. (2006). El impacto de la migración en la
salud: el caso de la diabetes, Encuentro en la
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
103
Escuela de Verano de Salud Pública. Centro
Internacional para la Migración y la Salud.
García-Beyaert, S. (2008). El derecho a la comunicación
efectiva, IV Congreso Internacional ESLETRA (El
Español Lengua de Traducción para la Cooperación
y el Diálogo). Toledo.
Gumperz, J. J. (1971). Language in Social Groups.
Stanford. Stanford University Press
Hale, S. (2007). Community Interpreting (1st ed.).
Basingstoke and New York: Palgrave Macmillan.
Halliday, M. A. K. (1970). Language structure and
language function. In J. Lyons (Ed). New Horitzons
in Linguistics. Harmondsworth, England: Penguin
Books.
Leanza, Y.; Miklavcic, A.; Boivin, I. & Rosenberg, E.
(2014). Working with interpreters. In L.J. Kirmayer
et al. (Eds.), Cultural Consultation: Encountering
the Other in Mental Health Care, International and
Cultural Psychology, DOI 10.1007/978-1-4614-
7615-3_5, New York: Sprinnger Science+Business
Media.
Linguamón. (2010). Els serveis de traducció,
interpretació i mediació en els processos
d’acolliment lingüístic a Catalunya. Barcelona.
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5,
104
Martincano, J. L. (2003). Manual de Medicina
Transcultural. Madrid: IMC.
Munoz, M. & Kapoor-Kohli, A. (2007). Les barrières de
langue. Le Médecin Du Québec, 42, 45–52.
Qureshi Burckhardt, A.; Wara Revollo, H.; Collazos, F.;
Visiers Würth, C. & El Harrak, J. (2009). La
mediación intercultural sociosanitaria:
implicaciones y retos. Norte de salud mental, 35.
Schreier, M. (2012). Qualitative Content Analyis in
Practice. Thousand Oaks: Sage Publications Ltd.
Valero-Garcés, C. (2014). Health, Communication and
Multicultural Communities: Topics on Intercultural
Communication for Healthcare Professionals.
Newcastle upon Tyne: Cambridge Scholars
Publishing.
Valero-Garcés, C. & Lázaro-Gutiérrez, R. (2008).
Investigación sobre la calidad de la comunicación
en la atención sanitaria al inmigrante, Investigación
y Práctica en Traducción e Interpretación en los
Servicios Públicos: Desafíos y Alianzas/ Research
and Practice in Public Service Interpreting and
Translation: Challenges and Alliances (pp. 255–
Burdeus-Domingo, N. (2018). Interpreting in Mental Health: An Effective
Communication Facilitation Practice. Current Trends in Translation Teaching and
Learning E, 5, 71 – 105.
105
275). Alcalá de Henares: Servicio de Publicaciones
de la Universidad.
Vásquez, C. & Javier, R. A. (1991). The problem with
interpreters: communicating with Spanish-speaking
patients. Hospital & Community Psychiatry, 42(2),
163–165.